Early exposure to stimulant medications and substance-related problems: The role of medical and nonmedical contexts

Sean Esteban McCabe; Phil Veliz; Carol J Boyd

doi:10.1016/j.drugalcdep.2016.03.019

Early exposure to stimulant medications and substance-related problems: The role of medical and nonmedical contexts

Drug Alcohol Depend. 2016 Jun 1:163:55-63. doi: 10.1016/j.drugalcdep.2016.03.019. Epub 2016 Apr 26.

Authors

Sean Esteban McCabe¹, Phil Veliz², Carol J Boyd³

Affiliations

¹ Institute for Research on Women and Gender, University of Michigan, 204 S. State St., Ann Arbor, MI 48109-1290, USA; Substance Abuse Research Center, University of Michigan, Ann Arbor, MI, USA. Electronic address: plius@umich.edu.
² Institute for Research on Women and Gender, University of Michigan, 204 S. State St., Ann Arbor, MI 48109-1290, USA.
³ Institute for Research on Women and Gender, University of Michigan, 204 S. State St., Ann Arbor, MI 48109-1290, USA; School of Nursing, University of Michigan, Ann Arbor, MI, USA; Addiction Research Center, University of Michigan, Ann Arbor, MI, USA.

Abstract

Background: The age of onset (early vs. late) and context (medical vs. nonmedical) of exposure to stimulant medications for attention-deficit/hyperactivity disorder (ADHD) have been identified as important factors in the addictive potential of these controlled medications. This study examines the role of medical and nonmedical contexts in the association between early exposure to stimulant medications and substance use and substance-related problems among adolescents.

Methods: A Web-based survey was self-administered by Detroit-area secondary school students (N=4755) between the 2009-10 and 2012-13 school years. The sample consisted of 51% females, 62% Whites, 32% African-Americans, and 6% from other racial categories.

Results: During the study period, an estimated 11.7% of respondents were ever diagnosed with ADHD. Approximately 6.7% (n=322) of respondents indicated lifetime medical use of prescription stimulants while 2.6% (n=124) indicated lifetime nonmedical use. The odds of substance use and substance-related problems were significantly lower among those who initiated earlier medical use of stimulant medications relative to later medical initiation. In contrast, the odds of substance use and substance-related problems were significantly greater among those who initiated earlier nonmedical use of stimulant medications relative to later nonmedical initiation.

Conclusions: More than one in every ten adolescents in this epidemiologically-derived community-based sample was diagnosed with ADHD. This is the first investigation to demonstrate that context (medical vs. nonmedical) plays a critical role in the relationship between early exposure to stimulant medications and the subsequent risk of substance-related problems during adolescence within the same diverse youth sample.

Keywords: Adolescence; Age of onset; Attention-deficit/hyperactivity disorder; Drug problems; Medical use; Nonmedical use; Stimulant medication; Substance use; Substance use disorder.

MeSH terms

Adolescent
Age Factors
Attention Deficit Disorder with Hyperactivity / drug therapy*
Attention Deficit Disorder with Hyperactivity / epidemiology*
Attention Deficit Disorder with Hyperactivity / psychology
Central Nervous System Stimulants / administration & dosage*
Child
Cross-Sectional Studies
Female
Humans
Male
Prescription Drug Misuse / prevention & control*
Prescription Drug Misuse / psychology
Schools
Substance-Related Disorders / epidemiology*
Substance-Related Disorders / psychology
Surveys and Questionnaires

Substances

Central Nervous System Stimulants

Abstract

MeSH terms

Substances

Grants and funding